Monitoring selenium replacement therapy
Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)
Patient Preparation: High concentrations of gadolinium, iodine, and barium are known to interfere with most metals tests. If gadolinium-, iodine, or barium-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.
-Metal Free B-D Tube (No Additive), 6 mL (T184)
-Metal Free Specimen Vial (T173)
Collection Container/Tube: 6-mL Plain, royal blue-top Vacutainer plastic trace element blood collection tube
Submission Container/Tube: 7-mL Metal-free, screw-capped, polypropylene vial
Specimen Volume: 0.8 mL
1. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.
2. Remove the stopper. Carefully pour specimen into a metal-free, polypropylene vial, avoid transferring the cellular components of blood. Do not insert a pipette into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.
3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.
|Specimen Type||Temperature||Time||Special Container|
|Serum||Refrigerated (preferred)||28 days||METAL FREE|
|Ambient||28 days||METAL FREE|
|Frozen||28 days||METAL FREE|
Monitoring selenium replacement therapy
Selenium is an essential element. It is a cofactor required to maintain activity of glutathione peroxidase (GSH-Px), an enzyme that catalyzes the degradation of organic hydroperoxides. The absence of selenium correlates with loss of GSH-Px activity and is associated with damage to cell membranes due to accumulation of free radicals.
The normal daily dietary intake of selenium is 0.01 to 0.04 parts per million (ppm), which is similar to the typical content of soil (0.05 ppm) and sea water (0.09 ppm). Selenium is found in many over-the-counter vitamin preparations because its antioxidant activity is thought to be anticarcinogenic. There is no supporting evidence that selenium suppresses cancer.
In humans, cardiac muscle is the most susceptible to selenium deficiency. With cell membrane damage, normal cells are replaced by fibroblasts. This condition is known as cardiomyopathy and is characterized by an enlarged heart whose muscle is largely replaced by fibrous tissue.
In the United States, selenium deficiency is related to use of total parenteral nutrition. This is therapy administered to patients with no functional bowel, such as after surgical removal of the small and large intestine because of cancer or because of acute inflammatory bowel disease such as Crohn disease. Selenium supplementation to raise the serum concentration to above 70 ng/mL is the usual treatment. Serum monitoring done on a semiannual basis checks the adequacy of supplementation.
Selenium toxicity has been observed in animals when daily intake exceeds 4 ppm. Teratogenic effects are frequently noted in the offspring of animals living in regions where soil content is high in selenium such as south-central South Dakota and northern-coastal regions of California. Selenium toxicity in humans is not known to be a significant problem except in acute overdose cases. Selenium is not classified as a human teratogen.
0-2 months: 45-90 ng/mL
3-6 months: 50-120 ng/mL
7-9 months: 60-120 ng/mL
10-12 months: 70-130 ng/mL
>1 year: 70-150 ng/mL
Selenium accumulates in biological tissue. The normal concentration in adult human blood serum is 70 to 150 ng/mL (0.15 parts per million) with a population mean value of 98 ng/mL. Optimal selenium concentration is age dependent (see Reference Values); children require less circulating selenium than do adults.
In the state of selenium deficiency associated with loss of glutathione peroxidase activity, the serum concentration is usually below 40 ng/mL.
Selenium is quite volatile; therefore, careful specimen collection is necessary to ensure accurate results.
Severe selenium deficiency may contribute to cardiomyopathy.
1. Muntau AC, Streiter M, Kappler M, et al: Age-related reference values for serum selenium concentrations in infants and children. Clin Chem. 2002 March;48(3):555-560
2. Gonzalez S, Huerta JM, Fernandez S, Patterson EM, Lasheras C: Food intake and serum selenium concentration in elderly people. Ann Nutr Metab. 2006;50(2):126-131
3. Skelton JA, Havens PL, Werlin SL: Nutrient deficiencies in tube fed children. Clin Pediatr (Phila). 2006 Jan-Feb;45(1):37-41
4. Gosney MA, Haldiman MF, Allsup SS: Effect of micronutrient supplementation on mood in nursing home residents. Gerontology. 2008;54:292-299
5. Burri J, Haldiman M, Dudler V: Selenium status of the Swiss population: assessment and change over a decade. J Trace Elem Med Biol. 2008;22(2):112-119
6. Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018
Selenium in serum is analyzed by inductively coupled plasma-mass spectrometry in dynamic reaction cell mode using gallium as an internal standard and a salt matrix calibration.(Unpublished Mayo method)
Monday through Saturday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.